RGHS to field Medicare approved Accountable Care Organization

Rochester General Health System is the first area health care organization to win the federal Centers for Medicare and Medicaid Services’ approval to field a Medicare approved Accountable Care Organization, CMS and RGHS officials said Monday.

The Rochester-area health system’s Medicare ACO was green lighted by CMS as one of 123 organizations in the agency’s most recent round of approvals.

CMS requires Medicare ACOs to meet 33 quality measures including patient satisfaction as well treatment outcomes and other health results.

Formed under Accountable Care Act provisions, ACOs are physician organizations designed to meet quality standards by providing tight care coordination among primary care doctors, specialists and hospitals. Improved care is supposed to yield cost savings, which doctors and payers can share as an extra financial bonus in a so-called gain-sharing arrangement.

The RGHS-affiliated Greater Rochester Independent Practice Association, a physician organization half owned by its roughly 900 members and 50-percent owned by RGHS, inked similar gain-sharing contracts earlier this year with Excellus BlueCross BlueShield and MVP Health Care.

First formed in 1996, GRIPA in 2006 became one of only three U.S. physician groups to win Federal Trade Commission approval as a clinically integrated organization, then meeting requirements similar to CMS’ ACO standards.

The RGHS Medicare ACO will treat some 12,000 area patients. The designation takes effect Jan. 1.

Before Monday, CMS had previously approved more than 360 U.S. Medicare ACOs including 125 last January. It plans to announce its next round of ACO approvals in mid-2014.

Before Monday, CMS had previously approved more than 360 U.S. Medicare ACOs including 125 last January. It plans to announce its next round of ACO approvals in mid-2014.